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Abstract

Psoriasis and dermatomyositis may appear together; on the other hand, cutaneous dermatomyositis can be challenging to diagnose, especially if presenting with psoriasiform clinical features. Gordon et al. review four patients with concomitant psoriasis and dermatomyositis at their institution (Figure 1) and 20 cases in the medical literature, for a total of 24 patients. The analysis of the series reveals a high rate of dermatomyositis being misdiagnosed with psoriasis, including true overlap versus psoriasiform-like rashes known to be associated with dermatomyositis. Concurrent disease should be more suspected in those with personal or family history of autoimmunity, when rashes of differing behaviour or morphology appear years apart, and when therapy for one condition might have induced the other. In the latter scenario, psoriasis may be triggered with oral corticosteroids for dermatomyositis, and conversely, treatment of psoriasis with biologics such as anti-TNF-alpha or anti-IL17 agents or phototherapy.

Psoriasis is known to be associated with an elevated risk of cardiovascular events; however, the role of systemic therapies for psoriasis in the development of such events is incompletely understood. Son et al. systematically review current evidence on the cardiovascular risks of systemic psoriasis treatments. From 14,744 records, 195 studies involving 1,795,823 patients were included (Figure 2). Methotrexate and tumour necrosis factor inhibitors consistently demonstrated cardiovascular protective effects, with reductions in myocardial infarction, stroke and cardiovascular mortality. Interleukin-17 inhibitors showed neutral to potentially beneficial cardiovascular profiles, whereas cyclosporine, retinoids and fumaric acid esters were associated with elevated cardiovascular risks. Evidence for IL-12/23 and IL-23 inhibitors was mixed. Long-term, high-quality studies are needed to clarify the safety of newer biologics and JAK inhibitors, particularly regarding cardiovascular events.

Chronic lower leg ulcers are common and affect the quality of life of patients, particularly in elderly populations. Van Zanten et al. retrospectively review the impact of punch grafting on pain in 74 patients with chronic lower leg ulcers treated at a single institution (Figures 3 and 4). Results reveal a significant decrease in pain and opioid use, with 30% of patients no longer requiring any analgesics. A minimally invasive procedure, such as punch grafting, is an effective intervention for chronic ulcer patients while promoting healing. Complications of punch grafting are minor, including small infections and donor-site issues.